Intraoperative indocyanine green (ICG) angiography is used in free flap surgery to evaluate the patency of vessel anastomosis. This study evaluated the outcomes of intraoperative ICG angiography in free flap surgery for head and neck cancer. This was a retrospective study of free flap reconstruction for head and neck cancer performed between 2015 and 2021.

The outcomes analyzed were total flap failure rate, reexploration rate, and flap salvage rate. Differences in outcomes were compared between patients treated using intraoperative ICG angiography and those treated without. Of the 520 cases of free flap surgeries from 486 patients included, 259 cases underwent intraoperative ICG angiography. In this group, there were 10 (3.9%) cases of total flap failure. In the non-ICG group, there were 22 cases (8.4%). There were 35 (13.5%) cases requiring reexploration in the ICG group and 40 (15.3%) in the non-ICG group. The difference was not statistically significant.

The flap salvage rate was 75.8% (25/33) in the ICG group and 51.4% (18/35) in the non-ICG group, which was a significant difference. We found that free flap surgery with intraoperative ICG angiography significantly decreased total flap failure rate and significantly increased salvage rate but did not significantly affect the reexploration rate.

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